Osteopathy vs Physiotherapy

Written by Stephen Sacks – Medically reviewed by Stephen Sacks – Last updated October 31, 2022

Who do you need,  an osteopath or a physiotherapist?

For many people, osteopathy and physiotherapy are often thought of as the same thing or confused as to the difference between the two. If you are in pain with musculoskeletal problems, you should know who would best suit your needs, an osteopath or a physiotherapist.

There are, in fact, many similarities between practitioners of the two professions. Both have the same aim – to treat people in order to reduce musculoskeletal pain, improve mobility and improve the quality of their patients’ lives. In addition, both have trained extensively in anatomy, physiology and pathology.

The main difference between the two is that osteopaths treat with their hands, and physiotherapists tend to treat using exercise and modalities. Osteopaths consider that all the parts of the body are intrinsically linked and the body has its own healing mechanism. Physiotherapists, on the other hand, although they will give advice about lifestyle to improve your general health and techniques to use in order to avoid injury, direct their attention primarily to improving that part of your body which is causing the problem.

The differences can be better appreciated if we consider how the two professions came about.

Osteopathy grew out of the medical profession. It was founded, in America, in the late 1800s by the physician and surgeon Andrew Taylor Still. His philosophy was that to achieve the best possible health all parts of the body should be treated together in a harmonious way. Osteopathy eventually came to Britain with the foundation of the British School of Osteopathy in 1917. The London College of Osteopathic Medicine was opened in 1946 and offered osteopathic courses to medical professionals. In 1993 it became a legally regulated profession.

Physiotherapy has its beginnings in various therapy treatments originating thousands of years ago in places like China, India and Greece. Most of these therapies involved exercise of one form or another. The aim of physiotherapy is to treat the particular area of the body which is the source of the pain rather than the body as a whole. In 1813 Henrick Ling introduced a therapy known as Swedish exercises. By the 1860s these exercises included massage and the use of exercise machines. In 1894, in Britain, four nurses founded the Chartered Society of Physiotherapy, but it didn’t acquire legal status as a professional organisation until 1900.  

Different Methods of Treatment

If you go to an osteopath the treatment you will receive will be different from that which you could expect from a physiotherapist. 

The Osteopath

The osteopath uses manipulation, massage and manual techniques to diagnose, treat and prevent musculoskeletal ailments. They will be concerned that your bones, muscles, ligaments and connective tissue are all functioning harmoniously. They will also be aiming at increasing your range of movement and encouraging blood flow through your body.

At a first meeting, the osteopath will ask you about your problem, general health and medical history. You can expect the osteopath to use their hands to examine you (palpation). The osteopath will be trying to find areas of strain, weakness, soreness or limitations on movement. The osteopath may also ask you to perform some movements yourself. They will then be in a position to be able to discuss your problem with you and to suggest treatment or a course of treatment. 

The treatment technique used by the osteopath will be manual therapy to return your body’s bones and tissues to their proper balance. It may include mobilising your joints to overcome stiffness, massage to relax and release muscle tension, articulation of your joints through a natural range of movement or manipulation of your spine to massage the soft tissue or loosen the joints of the vertebrae. The osteopath may also apply a muscle energy technique which requires you to push against them while they apply a counter force. This technique is used to increase the range of motion in a joint. There are numerous similar techniques which your osteopath may consider appropriate.

There is no specific limit to the number of visits you have, and your course of treatment will depend on your symptoms. Osteopathy isn’t generally available on the NHS, and most people pay privately.

The Physiotherapist

The physiotherapist will also use manipulation and massage for much the same reasons as the osteopath; to improve blood circulation, improve movement and relieve pain. However, the physiotherapist may also suggest other treatments such as acupuncture or ultrasound.

A first visit to a physiotherapist will primarily be an assessment of your general medical history and the history of your specific condition. As part of the assessment, you will probably be asked to perform some movements to show how your condition affects you. Perhaps at the first visit, but certainly on subsequent visits, you will be asked to do exercises and continue them at home. These home exercises form a very important part of the treatment and are a major difference between physiotherapy treatment and osteopathy treatment. 

On subsequent visits to the physiotherapist, there will be follow up sessions for reassessment and for new exercises to be tried out. These exercises are intended to improve movement and strength in the particular part of the body affected, and also in your body as a whole, so that you can maintain and increase your physical activity. Other treatments sometimes used by the physiotherapist may include acupuncture to reduce pain and increase recovery, transcutaneous electrical nerve stimulation also to relieve pain, and ultrasound treatment. The use of ultrasound is thought to increase blood flow and cell activity in order to help with the healing process and also reduce pain.

In general, you could expect to have between 5-7 physiotherapy sessions. After that, you would be expected to continue exercises on your own, in effect making you responsible for your own care and recovery. Physiotherapy is available on the NHS and you are generally referred by a doctor.

The choice is yours. Some people may feel that they would gain more benefit from the personal attention and individually prescribed course of treatment offered by the osteopath. For others, it may be that they would prefer the physiotherapy route, learn the relevant exercises and take more responsibility for their own recovery. There is even a third option, to employ the advantages of both osteopathy and physiotherapy.